Michigan Ear Institute

Surgery for ear infections
Tympanoplasty and Mastoidectomy

Jack M Kartush, MD August 21, 1998

There are two parts to our hearing mechanism: mechanical and electrical. Infections usually involve the mechanical or conductive system which picks up sound that enters the ear canal and vibrates the ear drum (know as the "tympanic membrane"). This in turn vibrates three tiny hearing bones: Hammer, Anvil and Stirrup ("Malleus, Incus and Stapes").

The Eustachian tube is the natural connection between the ear and the nose. It helps ventilate the middle ear as well as the mastoid, which is an air-filled sinus or honeycomb behind the ear.

Coursing through the ear is the facial nerve. It helps move the face and also provides for some of the taste fibers to the tip of the tongue.

Ear infections can lead to holes of the eardrum and, sometimes, an abnormal skin growth called cholesteatoma. This growth can slowly eat away at the eardrum, hearing bones and mastoid. Rarely, it can cause deafness, dizziness, facial paralysis and even death.

"Tympanoplasty" is the medical term for repairing ear drums. It is often combined with 1) repair of the hearing bones ("Ossicular Chain Reconstruction" = OCR) and cleaning of the mastoid ("Mastoidectomy").

The following is a pictorial review of some surgical techniques of Tympanoplasty.

For PHYSICIANS who desire more detail, please see: Kartush JM: Ossicular Chain Reconstruction: Capitulum to Malleus. Otolaryngologic Clinics of North America. E. Monsell (ed.) W. B. Saunders, vol 27: 689-715, l994.

REPRINTS and a VIDEO are available for physicians upon request.


 

1

FIGURE 1 shows four different types of ear drum perforations. Different surgical techniques are tailored for each type of perforation.


2

FIGURE 2 shows how cartilage from the outer ear can be used as a graft to rebuild an ear drum especially in children with recurring perforations or collapsing drums.


3

FIGURE 3 shows the first two steps in a Medial Tympanoplasty: Preparation of the ear drum.


4

FIGURE 4 shows the last two steps in a Medial Tympanoplasty: Placement of the graft underneath the drum.


5

FIGURE 5 shows the first two steps in a Lateral Tympanoplasty: Preparation of the ear drum.


6

FIGURE 6 shows the last two steps in a Lateral Tympanoplasty: Placement of the graft over the drum but underneath the skin.


7

FIGURE 7 shows how many tympanoplasties are performed at Michigan Ear Institute using A) an "H-Flap" to prepare the drum and, B) an "Over-Under tympanoplasty" which combines many of the advantages of both Medial and Lateral tympanoplasty.


8

FIGURE 8 shows how cartilage can be used to repair drums and eroded bone from cholesteatoma.